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Key Performance Indicators Slide 1version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Prof. Dr. F. Vanstapel, MD PhD
Laboratoriumgeneeskunde
UZ KULeuven
Measurable Facts to
Tune Execution of the Business Plan
Requirements of Standards Teaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 2version 100105
Cited from ISO 15189:2007
Key Performance Indicators
Requirements of StandardsSlide 3version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
4.1.6 Laboratory management shall ensure that proper communication processes are established within the laboratory and that communication takes place regarding the effectivenessof the quality management system.
4.12.4 Laboratory management shall implement quality indicators for systematically monitoring and evaluating the laboratory’s contribution to patient care. When this program identifies opportunities for improvement, laboratory management shall address them regardless of where they occur. Laboratory management shall ensure that the medical laboratory participates in quality improvement activities that deal with relevant areas and outcomes of patient care.
Cited from JCI
Key Performance Indicators
Requirements of StandardsSlide 4version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
QPS.3.2 Clinical monitoring includes those aspects of laboratory services selected by the leaders.… Clinical monitoring data are used to study areas targeted for improvement.
KPIDefinition
Key Performance Indicators
Requirements of StandardsSlide 5version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
2. Proper communication within the laboratory regarding the effectiveness of the system.
1. Indicators for systematically monitoring and evaluating the laboratory’s contribution in improving relevant areas and outcomes of patient care.
Requirements of StandardsTeaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 6version 100105
Pre-Test
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Teaching GoalsSlide 7version 100105
1. The introduction of KPI’s is important for compliance with ISO-15189 and other standardsfor policing the laboratory
2. The introduction of KPI’s results in increased motivation of employee’simproved performancea net benefit over overhead investment in KPI’s
all of the abovenone of the above who secretly thought this ?
The validity of the concept is questioned. KPI’s are seen as an instrument of repression / coercion. Why this negative premonition ?
Pre-Test
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Teaching GoalsSlide 8version 100105
3. To setup KPI’s define new statisticsuse existing statistics make statistics available for the management reviewpost statistics periodicallypost statistics publicly
Teaching goal: By understanding the answer to the above questions, to understand - how to select (& validate) KPI’s - how to go about their implementation
Requirements of StandardsTeaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 9version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Intuitive IntroductionSlide 10version 100105
Biology is the prime exampleof the Science of Cybernetics
(Norbert Wiener, Ross Ashby)
Life= Open Systems maintaining Steady States
= Physiology of Permanence
Key Performance Indicators
Intuitive IntroductionSlide 11version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Liver
PlasmaGlucose
Hepatic Output
Peripheral Disposal
Muscle Adipose
LipidAerobic
Input
AnaerobicLabour
Glycogen
Glycogen
“Cori Cycle”
PlasmaLactate
Glycolysis
“Cardiac Work”
Hepatic Branch
+
In-put
PlasmaFFALipolysis
Peripheral Branch
“Randle Cycle”Glucose-FFA Loop
_
Substrate-Product Cycle
Substrate Competition
The glucose loop
Sedentary
+
ObesityStress
Sedentary
Key Performance Indicators
Intuitive IntroductionSlide 12version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Liver
PlasmaGlucose
Hepatic Output
Peripheral Disposal
Muscle Adipose
LipidAerobic
Input
AnaerobicLabour
Glycogen
Glycogen
“Cori Cycle”
PlasmaLactate
Glycolysis
“Cardiac Work”
Hepatic Branch
+
In-put
PlasmaFFALipolysis
Peripheral Branch
“Randle Cycle”Glucose-FFA Loop
_
Substrate-Product Cycle
Substrate Competition
The insulin-glucose loop
Sedentary
+
ObesityStress
Sedentary
PlasmaInsulin
(Remote)LymphInsulin
PancreasPancreasInsulin
Glucagon__
+
Glucose-Insulin Loop
+
__
__
+
+
__
NIDDM
IDDM
The glucose-insulin axis works (feedback cycle) because:
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Intuitive IntroductionSlide 13version 100105
- There is an underlyingmetabolic machinery at work
- That system has its own characteristic set-point
- Hormonal control resetsthe set-point to a desirable level
- In pathologic conditionsthe actual set-point differs
Summary 1/2
Physiology: Your Business:The PDCA cycleis not a fictional construction
- Your business is a system(aufbau & ablauf)
- That system has its own level of performance
- Management setsperformance goals
- To that end a signal is sensed & processed
- A KPIis measured & communicated
- Aberrant conditionsrequire action
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Intuitive IntroductionSlide 14version 100105
Summary 2/2
The PDCA cycle is not a fictional construction, but
If your PDCA-cycle doesn’t work, it must be sick somewhere ?
The patho-physiology of the PDCA-cycle is the topic of this lesson
a cybernetic system = a system that can function by design
IDDM (Type-1 DM) : Interrupted loop NIDDM (Type -2 DM) : Insulin resistance & irresponsiveness Sedentary lifestyle : No Pull on Glc-compartment ….
PATHOLOGY
Requirements of StandardsTeaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 15version 100105
Step 1. What do you want ? = Relevance
Step 2. Ask the right question = What is the problem to solve ?
Step 3. Why doesn’t it work ?= What were your tacit wrong underlying assumptions ?
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 16version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design
Step 1. What do you want ? What are your Business Goals ?
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 17version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design = Relevance
What is your core-business ? What do you want to achieve ? What do you need for that ?
Recipe: Voice of the Customer (VOC) Balanced Score Board / SWOT analysis
Step 1. What do you want ?What are your Business Goals ?
Step 2. Ask the right question = What is the problem to solve ?What are necessary conditions to achieve your goal ?
Performance Limiting Variables= determines the level of Value Generated
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 18version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design = Relevance
KPIDefinition 1
Of course it is important to manage critical resources
Don’t provide excuses to wait for “external” solutions, in stead of thinking-up innovative alternatives !!!
PATHOLOGY
Step 1. What do you want ?What are your Business Goals ?
Step 2. Ask the right question = What is the problem to solve ?What are necessary conditions to achieve your goal ?
Performance Limiting Variables= determines the level of Value Generated
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 19version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design = Relevance
KPIDefinition 1
Of course it is important to manage critical resources: = be aware of opportunity costs = stick to your core-business
Resources hijacked for hidden agenda’s of stake-holders
PATHOLOGY
Step 1. What do you want ?What are your Business Goals ?
Step 2. Ask the right question = What is the problem to solve ?What are necessary conditions to achieve your goal ?
Performance Limiting Variable= determines the level of Value Generated
How will you steer the course ? Value to be Generated translated into Objectives Objectives translated into Accountable Targets
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 20version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design = Relevance
KPIDefinition 1
KPIDefinition 2
Performance IndicesTriad: (intangible) Values –
Objectives –(tangible) Targets not defined
PATHOLOGY
Step 1. What do you want ?What are your Business Goals ?
Step 2. Ask the right question = What is the problem to solve ?What are necessary conditions to achieve your goal ?How will you steer the course ?
Step 3. What are your underlying assumptions ?Do you understand your business-model ?Do you understand stake-holder objectives ?
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 21version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design = Relevance
Assumptions are tacitly taken for grantedand are never questioned
PATHOLOGY
Understand your Business Model- Understand environment in which you operate - Understand Stake-holder Objectives
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 22version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
My Core Business is Laboratory Diagnosis - What is the Business Environment ? - What are Requirements
of the Diagnostic Process ?- What are Remediable Weaknesses
in the Diagnostic Process ?
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 23version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
The Laboratory Diagnosis Business Environment
Managed Health Carenot a free market but a subsidised system 5 parties: patients, insurers, government
health care providers, industry (pharmaceutical, ...) Evolve towards
consolidationto maximize
share of subsidies Generic KPI area’s:
Costs per product
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 24version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
The Laboratory Diagnosis Business Environment
Managed Health Carenot a free market but a subsidised system 5 parties: patients, insurers, government
health care providers, industry (pharmaceutical, ...) Diagnostic assets
becoming commodities
Generic KPI area’s: Costs per productConsultative services
What is your Vision ? Lab as a production platform ?Lab as a consultative service ?
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 25version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
The Laboratory Diagnosis Business Environment
Information Technology5 parties: patients, insurers, government
health care providers, industry (pharmaceutical, ...)
Evolve towards integratedwhole business systems
Governance by patient of centralized databasetechnically feasible
True intelligent systemstechnically feasible
Generic KPI area’s: Business integrationIT integration
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 26version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
The Laboratory Diagnosis Business Environment
ConflictingInterests
Patients
Health Care ProvidersInsurers
Health Care Industry
Government
What is your Vision ? Equitable Health Care ? The biggest piece of the cake ?
Generic KPI area’s: Market shareReturn / Investment
Understand your Business Model- Understand environment in which you operate - Understand Stake-holder Objectives
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 27version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
My Core Business is Laboratory Diagnosis - What is the Business Environmental ? - What are Requirements
of the Diagnostic Process ?- What are Remediable Weaknesses
in the Diagnostic Process ?
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Requirements of any diagnostic tool
- Relevant- Accurate - Timely - Accessible - Understandable - Comparable - Coherent - Complete - Right price / costs
= fit forpurpose
= purposive
Specs / targets cfr. method validation file
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 28version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Logistic requirements of laboratory test
- Relevant : position / function in care algorithm(s) ?
- Accurate : sampling design
- Timely : timing / TAT with respect to care program(s)
- Accessible : test request / reporting of results & conclusions
- Understandable : cumulative reports / reference & decision limits
- Comparable : over methods / time frames
- Coherent : with other tests & procedures
- Complete : identification of lacking / censored data
- Right price/costs : low financial & user burden to patients & medical staff
(non exhaustive list)
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 29version 100105
Generic KPI area’s: Implementation of Care PathsConsultative servicesTAT, cost
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Analytical requirements of laboratory test
- Relevant :
- Accurate : data processing / analytical traceability
- Timely :
- Accessible :
- Understandable : traceability to the applicable clinical studies
- Comparable : commutability over methods / time frames
- Coherent : diagnostic specificity of measurement
- Complete :
- Right price/costs : process excellence
(non exhaustive list)
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 30version 100105
Generic KPI area’s: Process Excellence
CorrectionsiQC-problems Cost / object
Balance Logistic / Analytical Requirements not respected
PATHOLOGY
Understand your Business Model- Understand environment in which you operate - Understand Stake-holder Objectives
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 31version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
My Core Business is Laboratory Diagnosis - What is the Business Environment ? - What are Requirements
of the Diagnostic Process ?- What are Remediable Weaknesses
in the Diagnostic Process ?
Right test for the right patient at the right time ? Right interpretation at the right time ?Right consequential action at the right time ?
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
report
Sample
Reagents
Instruments
Controls
Calibrators
collectcondition
obtain
obtain
obtain
install
transport
store
store
store
maintain
conditionaliquot
conditionformulate
conditionformulate
conditionformulate
setup
calibrate measure
transmissiongeneration
transcriptionLIS
Operators train
Interpret
Use
RequestLabTest
Treat
OUTCOME
BRAIN-TO-BRAINCYCLE
Diagnostic Workup
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 32version 100105
Generic KPI area’sTAT (B2B)Consultative servicesCritical value reporting…
RISK ANALYSIS - FAULT TREE in Laboratory Diagnosis
ISO/TS 22367:2008
LOGISTICS
Wrong FocusPATHOLOGY
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Method Validation Process
Clinical ScenarioInventory of MeansSelection of Means
Requirements ?Suitability ?
Risk Analysisdetermine medicallyImportant Errors
Select AppropriateControl Procedures
Implementation
Evaluation ofClinical Path
PatientSymptoms
TreatmentEvaluation
Model- differential diagnosis- measurement model
Diagnostic Process
Analytical Process
Test RequestSampling
Analysis Report
Generic KPI:Diagnostic Acuity
Generic KPI:Process Excellence
Generic KPI:Outcome Care ProgramNumber to Treat / Days Hospitalization / …
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 33version 100105
RISK MANAGEMENT - METHOD VALIDATION
Wrong Focus
PATHOLOGY
Summary: Values – Objectives – Targets
Key Performance Indicators
Operational Definition : Defining generic KPI’sSlide 34version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Vision
&
Strategy
External
Stakeholders
Inta
ngib
le
goods
Internal
Stakeholders
Customer
Perception
Internal
Processes
Learning
Knowledge
Financial
Balance
(Kaplan, Norton)
Tangib
le
goods
Your KPI is purposeless
= does not relate to VALUE
PATHOLOGY
Requirements of StandardsTeaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 35version 100105
Step 3. What are your underlying assumptions ?Do you understand your business-model ?
Do you understand stake-holder objectives ?
You assume that “measuring” results in “a beneficial effect”
What are necessary conditions for your KPI
to give the right stimulus ?
= related to incentives ?
= do you have sufficient lay-way to operate ?
Key Performance Indicators
Operational Definition : The PDCA-cycleSlide 36version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design = Effectiveness
KPIDefinition 3
Incentives management ? Project management ? No stick
to hit the dogPATHOLOGY
Do
Plan
Check
Act
KPI’s stem from Intelligent Design
1. Define goal = Value you want to create2. Define objective = Target to aim at
3. Make achievements accountable4. Analyse deviation (variation) from set targets
5. Stay focused, Stay on track
Concept-driven
Fact-driven
Key Performance Indicators
Operational Definition : The PDCA-cycleSlide 37version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational Definition
FACTS likely to influence decisions = RELEVANT EVIDENCERELEVANT EVIDENCE leading to a DECISION = a DIAGNOSTIC PROCESS
KPIDefinition 4
KPI ’s as a diagnostic process
Key Performance Indicators
Operational Definition : The PDCA-cycleSlide 38version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational Definition
Diagnostic scenario’s - is your patient sick ?
- does the patient respond to your therapy ?
- does response persists ?
A diagnosis only becomes a diagnosis
by becoming consequential( = to reinforce the right action at the right time )
KPIDefinition 3
bench marking
project management
process care
Act upon KPI = Performance-Limiting
Variables
Make stakeholder accountable for KPI = delivered outcome
key to their Interests
Do
Plan
Check
Act
Key Performance Indicators
Operational Definition : The PDCA-cycleSlide 39version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational Definitionfrom Key Conditions to Key Deliverables
Concept-driven(insights in Business Model)
Fact-driven
MANAGEMENT
WORKFLOOR
Incentive = tension between the actual and the desired
You are PUSHING Quality in stead of your (internal) stakeholders PULLING Quality
PATHOLOGY
Operational Definition
Optimized Stable Processes
Key Performance Indicators
Operational Definition : The PDCA-cycleSlide 40version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Tool : Statistical Process Control
Do
Plan
Check
Act
Developing Projects
Tool : Key Performance Indicators
Act
Act
Do
DoPlan
Check
Plan
Check
Plan
KPIDefinition 5
Learning Organization
For as long as the process is in use(In principle) fixed set-points
For as long as project realization takesSet-point(s) evolve(s)Intermittent Evaluation & Care
narrows cone of uncertainty
The Learning Experience
Question: Why ?
Key Performance Indicators
Operational Definition : The PDCA-cycleSlide 41version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Expectations
Experiences
The answer: Because of
Experiences & Expectations
α and ώ
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Modeling : When will iterations converge ? - law of minimal required complexity- anything more than that will be undetermined
Ross Ashby
The Learning Experience
Key Performance Indicators
Operational Definition : The PDCA-cycleSlide 42version 100105
Requirements of StandardsTeaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 43version 100105
Management
Workfloor
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
author & actor
integrate
information
communicate business goals
& dissipate
knowledge
facilitate
communication
Quality
System
Key Performance Indicators
Operational Definition : The Learning OrganizationSlide 44version 100105
coordinate
keep focus
Project
Management
The Learning Organization (Aufbau)
Top Management
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Workfloorauthor & actor
Key Performance Indicators
Operational Definition : The Learning OrganizationSlide 45version 100105
The Learning Organization (Aufbau)
Workfloorauthor & actor
Workfloorauthor & actor
Middle Management
Neuronal Network
Hierarchical system
for processing
information & knowledge
Neuronal hierarchical system is a prerequisite, but insufficient condition
Top Management
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Workfloorauthor & actor
Key Performance Indicators
Operational Definition : The Learning OrganizationSlide 46version 100105
The Learning Organization (Aufbau)
Workfloorauthor & actor
Workfloorauthor & actor
Middle Management
Neuronal Network
Hierarchical system
for processing
information & knowledge
Choose for Robustness not for Fragility
Process information
Decouple failing systems
Communicate
good & bad news
up & down
Role of middle management
Middle management has to be held accountable
for execution of the business plan
i.s.o. its own hidden agenda’s
PATHOLOGY
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Operational Definition : The Learning OrganizationSlide 47version 100105
The Learning Organization (Ablauf)
Is learning a valued business goal ?
Is learning process organized / facilitated ?
Are measurable objectives (KPI’s) defined ?Is staff made accountable ?
Is learning understood ?
Is the process managed ?
Is the chosen learning KPI adequate ?
Project Outcome ?Timeliness of outcome ?
Participation ?
KPI definition 5To learn is to reinforce desired behaviour
Cooperation and Synergism
Knowledge sharing:
Knowledge building:
Open debate (Popper)
Key Performance Indicators
Operational Definition : The Learning OrganizationSlide 48version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
The Learning Organization Why aren’t we
innovative ?
Monopolize power ?
Eminence - Dogmatic ?
Competition ?
Is learning a valued business goal ?
Is learning process organized / facilitated ?
Are measurable objectives (KPI’s) defined ?Is staff made accountable ?
Is the process understood ?
Is the process managed ?
Is the chosen KPI adequate ?
Project Outcome ?
Participation ?
Cooperation and Synergism
Knowledge sharing
Knowledge building
Open debate
Number of publications ?
Investigator grants ?
Are the requiredresources there ?
KPI reporting onresources
may reinforcewrong behavior ?
PATHOLOGY
Key Performance Indicators
Operational Definition : The Learning OrganizationSlide 49version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Is the process understood ?
Monopolize power ?
Competition ?
Wasteful competitionInnovative cooperation
scarcity abundance
resources (Economic paradigm)
Temporary advantage through
Specialisation
SurvivalthroughAdaptability
Cooperation and Synergism
Knowledge sharing
Open debate
Eminence - Dogmatic ?
(Darwinian paradigm)
The Learning Organization Why aren’t we
innovative ?
Altruistic strategies Egoistic strategies
Requirements of StandardsTeaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 50version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Operational Definition : The Political ArenaSlide 51version 100105
With scarcity, abundance, cooperation, competition,
resource management, we have entered
the Political Arena
Not the governing coalition against ..., but
Not to wail about lacking resources, but
we are in it together
to work within the given constraints
Not settling for the status quo, but
innovative thinking (a quantum leap)
Not using KPI’s to serve your arguments, but
using data to achieve objectives
The KPI’s are hijacked,
as they suit hidden agenda’sPATHOLOGY
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Operational Definition : The Political ArenaSlide 52version 100105
The Political ArenaKeep the Communication Channels OPEN
Management
Workfloorauthor & actor
integrate
information
communicate business goals
& dissipate
knowledge
facilitate
communication
Quality
System coordinate
keep focus
Project
Management
Middle Management
Workfloorauthor & actor
Workfloorauthor & actor
Enacting hidden agenda’s
PATHOLOGY
Coalition shifts withbreakdown of information &
knowledge processinghierarchical lines
PATHOLOGY
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Ownership of processes
Key Performance Indicators
Operational Definition : The Political ArenaSlide 53version 100105
- The organization shall identify & assign owners to main processes- Ownership does not make one automatically an expert
expert behavior is an attitude = a general competenceexperts share knowledge
ownership allows one to identify with and to act morally owners have to be held accountable
- The “quality control/assurance system” should facilitate problem solving, but it should never assume ownership
- Develop a culture op “knowledge sharing”hurdles to knowledge sharing:
knowledge is power not sharing knowledge makes one irreplaceable
make “ expansion of shared knowledge ” a measurable and accountable “ business target ”
culture = open (fact-, not opinion-driven) debate ≠ dogmatic
actors not madethe authors of change
PATHOLOGY
no recognition forcontributions
PATHOLOGY
Integral Quality ManagementHow to optimize the functioning of your people ?
1. Focus on clients 2. Leadership3. Involvement of People4. Process approach5. System approach to management6. Continual Improvement7. Factual approach to decision making 8. Mutually beneficial supplier relationships
Quality is a task of allOwnership of ProcessesLearning OrganizationCoaching
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Operational Definition : The Political ArenaSlide 54version 100105
Lack of an OPEN, EMPATHIC, LEARNING CULTURE
From : command, control, constraint, contractTo : discipline, trust, stretch, support
PATHOLOGY
Requirements of StandardsTeaching GoalsIntuitive IntroductionOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcomeWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 55version 100105
Reinforcement of the desired outcome
Actual
Situation 1
Actual
Situation 2
Desired
Set-point
Negative Feedback
Δ * -k < 0
Δ * -k > 0
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 56version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
+
0
_
KP
I resu
lt
The Learning Process
Reinforcement of the desired activities
Addressing the Processes in your Organization
Desired
Output
+
0
_
Δ * -k < 0Output 1
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 57version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Undesired
Events
Average
Negative
Reinforcement
POKA
Fail-safe design
Definition 6: To learn from your mistakes
The KPI’s are not used to learn from
PATHOLOGY
Step 1. What do you want ? = Relevance
Step 2. Ask the right question = What is the problem to solve ?
Step 3. Why doesn’t it work ?= What were your tacit wrong underlying assumptions ?
Step 4. The right solution is the best solution ?= elegant = simple, the least steps, robust ?
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 58version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design
Step 4. The right solution is the best solution ?= elegant = simple, the least steps, robust ?
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 59version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design
People are “programmed” to make “ecological” decisions = to economize on efforts = to negotiate risk
by- Bayesian approach = minimize risk, by making an informed gamble- Heuristic approach = avoid risk, by a work-around- Economic approach = be aware of opportunity costs
Not to recognize that
a procedure which is not accepted
probably is a bad procedure
PATHOLOGY
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 60version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
So kompliziert wie nötig,so einfach wie möglich
Gϋnther Erdmann(German composer)
Reinforcement of the desired activities
Addressing the PEOPLE in your Organization
Desired
Output
+
0
_
Δ * -k < 0Output 1
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 61version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Undesired
Events
Average
Negative
Reinforcement
POKA
Fail-safe design
Definition 6: To learn from your mistakes
To learn is
a cooperative endeavor
positive incentive:
recognize authorship of the actors
The business culture is
not inductive for learningPATHOLOGY
Reinforcement of the desired activities
Addressing the PEOPLE in your Organization
Desired
Output
+
0
_
Δ * -k < 0Output 1
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 62version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Undesired
Events
Average
Negative
Reinforcement
Punishment
& Rewards
Extinguish
by removal of
collateral incentive
Positive
Reinforcement
Positive incentive
Definition 6: to condition your coworkers
A culture of coercion
in stead of coachingPATHOLOGY
(after Skinner
Conditioning paradigm)
Reinforcement of the desired activities
Addressing the PEOPLE in your Organization
Undesired
Output 1
Desired
Output
+
0
_
Average
Output 1
Incentives
Punish
Extinguish
Intrinsic motivation
the desire for self-realization
= desire to learn
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 63version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Incre
asin
g e
ffic
ien
cy
Positive incentives:
persists as long as
scarcity is not satisfied
Negative incentives:
removal of a negative effect by
engaging in desired behavior
Punishment & Rewards:
engaging in undesired behavior
elicits a negative stimulus
engaging in desired behavior
elicits a reward
Inefficient:
requires persistent
control
Creates resentment
Reinforcement of the desired activities
Addressing the PEOPLE in your Organization
Undesired
Output 1
Desired
Output
+
0
_
Average
Output 1
Incentives
Punish
Extinguish
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 64version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Incre
asin
g e
ffic
ien
cy
Punishment & Rewards:
If so inefficient,
why is this then second nature to us ?
- We react aggressively
when the ideas don’t come ?
when we fear for our authority ?
- An aggressive / authoritarian stance
prevents worse aggression ?
Reinforcement of the desired activities
Addressing the PEOPLE in your Organization
Undesired
Output 1
Desired
Output
+
0
_
Average
Output 1
Incentives
Punish
Extinguish
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 65version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Incre
asin
g e
ffic
ien
cy
Punishment & Rewards:
If so inefficient,
why is this then second nature to us ?
- We react aggressively
when we fear for our authority ?
R) True AUTHORITY stems from
TRUST,
PREDICTABILITY,
FAIRNESS
necessary conditions for
self-realization of your co-workers
= COMMUNICATE
THE BUSINESS PLAN
= GENUINE COACHING
= RECOGNIZE AUTHORSHIP
Reinforcement of the desired activities
Addressing the PEOPLE in your Organization
Undesired
Output 1
Desired
Output
+
0
_
Average
Output 1
Incentives
Punish
Extinguish
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 66version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Incre
asin
g e
ffic
ien
cy
Punishment & Rewards:
If so inefficient,
why is this then second nature to us ?
- When the ideas don’t come,
we fear for our authority ?
R) You don’t need
to have the answer
You need
to find the solution together
Lack of a culture of togetherness
= not inductive for learning
PATHOLOGY
Reinforcement of the desired activities
Addressing the PEOPLE in your Organization
Undesired
Output 1
Desired
Output
+
0
_
Average
Output 1
Incentives
Punish
Extinguish
Does the reinforcing stimulus
relate reliably to
value for you ?
Satiety
relevant incidents ?
Contingency
actual events ?
Immediacy
Key Performance Indicators
Operational Definition : Reinforcing desired behaviorSlide 67version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
The stimulus is
not fit for purpose / not adequatePATHOLOGY
Summary
Key Performance Indicators
Operational Definition : SummarySlide 68version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
SpecificMeasurableAttainableRelevantTimely
Contingency
ConsequentialSatiety
Immediacy
Learning pole of the definition
Diagnostic pole of the definition
The diagnostic characteristics of your KPI
are not fit for purpose
PATHOLOGY
Teaching GoalsIntuitive IntroductionRequirements of StandardsOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcome & behaviorWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 69version 100105
What is your largest cost-component ?Why then work with People ?
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Operational Definition : Working with peopleSlide 70version 100105
- Versatility - Flexibility- Problem-solving abilities
People vs Machines
Human Resource Management
not overlooked by KPI’sPATHOLOGY
Generic KPI area’s: Degree of Cross-training Flow over workplacesLeadership…
= measurable elements, suitable forperformance appraisal interviews
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Operational Definition : Working with peopleSlide 71version 100105
HUMAN RESOURCE MANAGEMENT :
Characteristics of expert (= intelligent) behavior
- Expert attitudes (after SR Covey)
- Confidence and self-reliance
- Value- / Purpose-oriented
- Empathic, Cooperative, Synergetic
- Expert problem solving skills (= intelligence)
- Can formulate the right question
- sticks to the purpose : Stays on track; Does not lose focus
- can visualize data sets in order to ask the right question
- Recognizes assignable variation and acts upon this
- Does not act on random variation
(recognizes problems without technical solution
does not introduce variation / deterioration by futile actions)
- Solves problems using the simplest, elegant and robust techniques
- Organizational talents: multitasking & time-management
- Learns continuously
- Self-observation : understands why actions / attempts to solve problems
/ communication of results and solutions fail and learns from this
- After recognizing failing approaches,
does not persist with fruitless attempts,
but switches to alternative approaches
Looking for strength in Quantity,
in stead of in Quality
PATHOLOGY
Summary: Integral Quality Management
1. Focus on clients 2. Leadership3. Involvement of People4. Process approach5. System approach to management6. Continual Improvement7. Factual approach to decision making 8. Mutually beneficial supplier relationships
Quality is a task of allOwnership of ProcessesLearning OrganizationCoaching
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Operational Definition : Working with peopleSlide 72version 100105
Lack of an OPEN, EMPATHIC, LEARNING CULTURE
From : command, control, constraint, contractTo : discipline, trust, stretch, support
PATHOLOGY
Teaching GoalsIntuitive IntroductionRequirements of StandardsOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcome & behaviorWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 73version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Method Validation Process
Clinical ScenarioInventory of MeansSelection of Means
Requirements ?Suitability ?
Risk Analysisdetermine medicallyImportant Errors
Select AppropriateControl Procedures
Implementation
Evaluation ofClinical Path
PatientSymptoms
TreatmentEvaluation
Model- differential diagnosis- measurement model
Diagnostic Process
Analytical Process
Test RequestSampling
Analysis Report
Generic KPI:Diagnostic Acuity
Generic KPI:Process Excellence
Generic KPI:Outcome Care Program
Key Performance Indicators
Nuts and BoldsSlide 74version 100105
INVENTORY of KPI Area’s
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Diagnostic Acuity
Analytical Process Excellence
Outcome Care Program
Key Performance Indicators
Nuts and BoldsSlide 75version 100105
INVENTORY of KPI Area’s
Reduction of avoidable errors (corrections) Reduction of superfluous corrections (=waste)Sampling (labeling, volume, hemolysis, ...)…
Therapy adjustments in function of results(diabetes treatment, antibiotics use, …)
Follow-up of alarm valuesFollow-up of corrections…
Total costs of care Number to treatDays to stay Number of (avoidable) complicationsVariance with care path ….
Organizational ExcellenceTATCost per resultHuman Resource Management
(degree of cross-training, … )…
Validation of KPI as a good Diagnostic Tool
Key Performance Indicators
Nuts and BoldsSlide 76version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
SpecificMeasurableAttainableRelevantTimely
Contingency
ConsequentialSatiety
Immediacy
Quantitative & Validated
attainable targetsrelated to concerns of process-owner
= purposive = relevant
Validation of KPI as a good Diagnostic Tool
Key Performance Indicators
Nuts and BoldsSlide 77version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
SpecificMeasurableAttainableRelevantTimely
Contingency
ConsequentialSatiety
Immediacy
Quantitative & Validated
inventory of statisticsdiscard what is wastekeep what is relevant
plan maintenance of your KPI(validation, set-points, ...)
Validation of KPI as a good Diagnostic Tool
Key Performance Indicators
Nuts and BoldsSlide 78version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
SpecificMeasurableAttainableRelevantTimely
Contingency
ConsequentialSatiety
Immediacy
Quantitative & Validated
error-free = good signal/noiseexpressed relative to an attainable goal
Validation of KPI as a good Diagnostic Tool
Key Performance Indicators
Nuts and BoldsSlide 79version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
SpecificMeasurableAttainableRelevantTimely
Contingency
ConsequentialSatiety
Immediacy
Quantitative & Validated
Effective signal = stimulusdetects relevant deviations from set-points
signals positive vs negative deviation from set-pointno refractory delays
can be directly interpreted, without extra analysis
Step 1. What do you want ?What are your Business Goals ?
Step 2. Ask the right question = What is the problem to solve ?What are necessary conditions to achieve your goal ?How will you steer the course ?
Step 3. What are your underlying assumptions ? Do you understand your business-model ?Do you understand stake-holder objectives ?
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design = Relevant & Optimized
Key Performance Indicators
Nuts and BoldsSlide 80version 100105
Step 4. The right solution is the best solution ?= elegant = simple, the least steps, robust ?
Step 4. The right solution is the best solution ?= elegant = simple, the least steps, robust ?
Key Performance Indicators
Nuts and BoldsSlide 81version 100105
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Operational DefinitionIntelligent Design
People are “programmed” to make “ecological” decisions = to economize on efforts = are willing to take a risk
provided they are not caught red handed
Not to invest in
contingency & immediacy
as prime “logistic” requirements
of a good “diagnostic” KPI
PATHOLOGY
Teaching GoalsIntuitive IntroductionRequirements of StandardsOperational Definition
Defining generic KPI’sThe PDCA-cycleThe Learning OrganizationThe political arenaReinforcing desired outcome & behaviorWorking with peopleNuts and Bolds
SummaryF. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
Structure of the PresentationSlide 82version 100105
Strategic Planning
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Analysis
StrenghtsWeaknessesOpportunitiesTreats
Objectives
SpecificMeasurableAttainableRelevantTimely
Key Performance Indicators
SummarySlide 83version 100105
Management
Workfloor
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
author & actor
integrate
information
communicate business goals
& dissipate
knowledge
facilitate
communication
Quality
System
Key Performance Indicators
SummarySlide 84version 100105
coordinate
keep focus
Project
Management
Open the Communication Channels
Middle Management
Workfloorauthor & actor
Workfloorauthor & actor
Communicate up & down
Process information
Decouple failing systems
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
When not to measure ?- Design from first principles - Fail-safe POKA-design
(except for the purpose of validation of POKA implementation)
When to measure ? - Analysis: identify rate-limiting steps & targets- Quantitative signals for process-steering
- convert in-tangible purposes into specific targets- have to be relevant & valid
- Before- and after-measurements - for maintenance of implemented policies - for internal marketing purposes
When to distrust / cancel measurements ? - Collected data hijacked for hidden agendas ? - Stimulus fuels undesirable reactions
Key Performance Indicators
SummarySlide 85version 100105
Don’t flood the Communication Channels
F. Vanstapel © - Laboratory Medicine - University Hospitals - K.U.Leuven
Key Performance Indicators
SummarySlide 86version 100105
KPI’s are a managerial tool measuring performance in key area’s
insist on process-ownershipembrace an active learning interaction
Take-home Message
1. The introduction of KPI’s is important for compliance with ISO-15189 and other standardsfor policing the laboratory
2. The introduction of KPI’s resulted in increased motivation of employee’san increase in perfomancea net benefit over overhead the opposite of the above